{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T02:34:50Z","timestamp":1779935690445,"version":"3.53.1"},"reference-count":20,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2022,4,25]],"date-time":"2022-04-25T00:00:00Z","timestamp":1650844800000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,2,7]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Several risk factors for adverse events after endovascular aneurysm repair (EVAR) have been described, but there is no consensus on their comparative prognostic significance, use in risk stratification and application in determining postoperative surveillance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>A scoping review of the literature was conducted to identify risk factors for adverse events after EVAR. Main adverse events were considered post-EVAR abdominal aortic aneurysm rupture and reintervention. Risk factors were grouped into four domains: (1) preoperative anatomy, (2) aortic device, (3) procedure performance and (4) postoperative surveillance. The Delphi methodology will be used to steer a group of experts in the field towards consensus organised into three tiers. In tier 1, participants will be asked to independently rate risk factors for adverse events after EVAR. In tier 2, the panel will be asked to independently rate a range of combinations of risk factors across the four domains derived from tier 1. A risk-stratification tool will then be built, which will include algorithms that map responses to signalling questions onto a proposed risk judgement for each domain. Domain-level judgements will in turn provide the basis for an overall risk judgement for the individual patient. In tier 3, risk factor-informed surveillance strategies will be developed. Each tier will typically include three rounds and rating will be conducted using a 4-point Likert scale, with an option for free-text responses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>Research Ethics Committee and Health Research Authority approval has been waived, since this is a professional staff study and no duty of care lies with the National Health Service to any of the participants. The results will be presented at regional, national and international meetings and will be submitted for publication in peer-reviewed journals. The risk stratification tool and surveillance algorithms will be made publicly available for clinical use and validation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055803","type":"journal-article","created":{"date-parts":[[2022,5,17]],"date-time":"2022-05-17T08:07:33Z","timestamp":1652774853000},"page":"e055803","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Risk factors, risk stratification and risk-specific surveillance strategies after endovascular aneurysm repair: study protocol for a Delphi study by the International RIsk Stratification in EVAR (IRIS-EVAR) working group"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-0406","authenticated-orcid":false,"given":"George A","family":"Antoniou","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc L","family":"Schermerhorn","sequence":"additional","affiliation":[{"name":"Divisions of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L","family":"Forbes","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Peter Munk Cardiac Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Cheng","sequence":"additional","affiliation":[{"name":"Bristol Medical School, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4630-6748","authenticated-orcid":false,"given":"Stavros A","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Mediterranean Hospital of Cyprus, Limassol, Cyprus"},{"name":"Medical School, European University of Cyprus, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7727-526X","authenticated-orcid":false,"given":"Jonathan","family":"Golledge","sequence":"additional","affiliation":[{"name":"Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia"},{"name":"Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia"},{"name":"Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hence J M","family":"Verhagen","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0529-7387","authenticated-orcid":false,"given":"Francesco","family":"Torella","sequence":"additional","affiliation":[{"name":"Liverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK"},{"name":"School of Physical Sciences, University of Liverpool, Liverpool, UK"},{"name":"Liverpool Centre for Cardiovascular Science, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,25]]},"reference":[{"key":"2025101812141586000_12.4.e055803.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31135-7"},{"key":"2025101812141586000_12.4.e055803.2","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1056\/NEJMoa1715955","article-title":"Open versus endovascular repair of abdominal aortic aneurysm","volume":"380","author":"Lederle","year":"2019","journal-title":"N Engl J Med"},{"key":"2025101812141586000_12.4.e055803.3","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ejvs.2019.11.030","article-title":"Editor's Choice - Endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term rata of randomised controlled trials","volume":"59","author":"Antoniou","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025101812141586000_12.4.e055803.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.09.050"},{"key":"2025101812141586000_12.4.e055803.5","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1177\/1526602820937432","article-title":"Prognostic significance of aneurysm sac shrinkage after endovascular aneurysm repair","volume":"27","author":"Antoniou","year":"2020","journal-title":"J Endovasc Ther"},{"key":"2025101812141586000_12.4.e055803.6","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9177"},{"key":"2025101812141586000_12.4.e055803.7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jss.2016.12.024","article-title":"An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement","volume":"217","author":"Png","year":"2017","journal-title":"J Surg Res"},{"key":"2025101812141586000_12.4.e055803.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2007.12.003"},{"key":"2025101812141586000_12.4.e055803.9","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2002.123991"},{"key":"2025101812141586000_12.4.e055803.10","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.ejvs.2020.08.049","article-title":"Risk stratification and risk specific surveillance for endovascular aneurysm repair","volume":"60","author":"Antoniou","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025101812141586000_12.4.e055803.11","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.ejvs.2020.09.004","article-title":"Response to \"Re 'European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-Iliac artery aneurysms'\"","volume":"60","author":"Wanhainen","year":"2020","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2025101812141586000_12.4.e055803.12","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/j.jvs.2019.08.247","article-title":"Prognosis review and time-to-event data meta-analysis of endovascular aneurysm repair outside versus within instructions for use of aortic endograft devices","volume":"71","author":"Antoniou","year":"2020","journal-title":"J Vasc Surg"},{"key":"2025101812141586000_12.4.e055803.13","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1024\/0301-1526\/a000844","article-title":"Prognostic significance of large diameter proximal aortic neck in endovascular aneurysm repair","volume":"49","author":"Antoniou","year":"2020","journal-title":"Vasa"},{"key":"2025101812141586000_12.4.e055803.14","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1177\/1538574417712648","article-title":"A systematic review of predictors of reintervention after EVAR: guidance for risk-stratified surveillance","volume":"51","author":"Patel","year":"2017","journal-title":"Vasc Endovascular Surg"},{"key":"2025101812141586000_12.4.e055803.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.311.7001.376"},{"key":"2025101812141586000_12.4.e055803.16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1300\/J021v01n03_02","article-title":"The Delphi method as a research tool in gerontological curriculum planning","volume":"1","author":"Yancik","year":"1981","journal-title":"Gerontol Geriatr Educ"},{"key":"2025101812141586000_12.4.e055803.17","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-37"},{"key":"2025101812141586000_12.4.e055803.18","first-page":"598","article-title":"The Delphi method","volume":"22","author":"Iqbal","year":"2009","journal-title":"Psychologist"},{"key":"2025101812141586000_12.4.e055803.19","unstructured":"Bristol Online Surveys . Available: https:\/\/www.onlinesurveys.ac.uk\/ [Accessed 27 March 2022]."},{"key":"2025101812141586000_12.4.e055803.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-055803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T19:14:23Z","timestamp":1760814863000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-055803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":20,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,25]]},"published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1136\/bmjopen-2021-055803"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-055803","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4]]}}}